Senior Claims Specialist, Medical Malpractice
New
S
SedgwickMedical malpractice insurance
United StatesFull-TimeSenior
Salary110,000 - 120,000 USD per year
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Job Details
- Experience
- Six (6) years of claims management experience or equivalent combination of education and experience required.
- Required Skills
- Microsoft OfficeClient relationship management
Requirements
- Six years of claims management experience, or an equivalent combination of education and experience.
- Bachelor's degree from an accredited college or university preferred.
- Licenses as required for the role.
- Professional certification applicable to the line of business preferred.
- In-depth knowledge of medical malpractice insurance principles and laws for the handled line of business.
- Knowledge of recoveries, offsets, deductions, claim and disability duration, and cost-containment principles.
- Knowledge of medical management practices and Social Security application procedures as applicable to the line of business.
- Proficiency with PC use and Microsoft Office products.
- Strong analytical, interpretive, organizational, negotiation, and interpersonal skills.
- Ability to communicate orally and in writing, including presentation skills, and work in a team environment.
- Credit security clearance, confirmed through a background credit check, is required.
Responsibilities
- Investigate complex medical malpractice claims and gather information to determine claim exposure.
- Manage claims through action plans toward appropriate and timely resolution.
- Conduct or assign investigations and report on new events, claims, and legal actions.
- Negotiate settlements, recommend settlement strategies, and prepare structured settlement proposals as needed.
- Calculate and assign reserves, then monitor their adequacy throughout the claim.
- Coordinate legal defense by assigning attorneys, supporting investigations, reviewing invoices, and monitoring compliance with client guidelines.
- Use cost-containment techniques and investigate fraud, subrogation, contribution, recovery, and case management opportunities.
- Represent the Company in depositions, mediations, and trial monitoring as needed.
- Communicate claim activity with clients, maintain client relationships, and ensure claim files and coding are accurate.
- Refer cases as appropriate and delegate work to and mentor assigned staff.
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